Provider Demographics
NPI:1407946585
Name:FJB MEDICAL GROUP
Entity Type:Organization
Organization Name:FJB MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:VISBAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-603-6868
Mailing Address - Street 1:1427 CALLE AMERICO SALAS
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-2140
Mailing Address - Country:US
Mailing Address - Phone:787-603-6868
Mailing Address - Fax:
Practice Address - Street 1:1427 CALLE AMERICO SALAS
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-2140
Practice Address - Country:US
Practice Address - Phone:787-603-6868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR164164208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty